How will my Medicare prescription drug costs in 2018 compare with 2017?

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  • March 20, 2018

Q: How will my Medicare prescription drug costs change in 2018, compared with 2017?

A: The Part D prescription drug deductible is a maximum of $400 in 2017, and that will increase slightly to $405 in 2018. Some plans have deductibles well under these amounts, but no plans can have deductibles that exceed $405 in 2018. After you pay your deductible, you pay copays (a fixed amount) or coinsurance (a percentage of the cost) for your medications until the total you and the plan have spent hits the lower threshold of the donut hole.

Due to changes adopted in the federal Affordable Care Act, Medicare’s Part D prescription drug coverage gap (i.e., the “donut hole”) is gradually closing.  In 2017, the coverage gap starts when an individual and the drug plan they’re enrolled in have spent a total of $3,700 on medications. For 2018, the coverage gap will start when total spending has reached $3,750.

Prior to 2010, Medicare Part D beneficiaries were on the hook for the full cost of their prescriptions while in the donut hole. But thanks to the Affordable Care Act, the percentage of drug costs that the patient pays while in the donut hole has been steadily declining over the last several years. In 2017, seniors only pay 40 percent of the cost of their brand-name drugs and 51 percent for generics while in the donut hole.

Stuck in Medicare’s ‘donut hole?’ A prescription discount card could help lower your costs.

In 2018, enrollees’ cost for prescription drugs will decrease again, to 35 percent for brand name drugs, and 44 percent for generics.

Once you and your drug plan have spent $4,950 in out-of-pocket drug costs for 2017, you leave the donut hole and become eligible for catastrophic coverage.  At that point, you will pay a small co-insurance payment for covered drugs for the remainder of the year. In 2018, the upper cap on the donut hole will increase slightly, to $5,000.

It’s important to remember that many seniors do not reach the donut hole in a given year, because their drug costs aren’t high enough. For those individuals, the deductible and the copay or coinsurance below the donut hole will be the most important factor in determining how much they spend on medications.

Since it’s common for Part D plans to have 25 percent coinsurance on medications before the donut hole (and after the deductible), some seniors may find that their costs go up from one year to the next, simply due to the rising prices for prescription drugs. If you’re paying 25 percent of the cost and the cost goes up, your portion goes up as well. According to a Wall Street Journal analysis, the median out-of-pocket cost for a medication purchased via Medicare Part D was $117 in 2015, up from $79 in 2011.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.